Mortality of IgA nephropathy patients: a single center experience over 30 years.
Mortality of IgA nephropathy patients: a single center experience over 30 years.
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DOI：
10.1371/journal.pone.0051225
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发表时间：
2012
期刊：
影响因子：
3.7
通讯作者：
Chin HJ
中科院分区：
文献类型：
--
作者：
Lee H;Kim DK;Oh KH;Joo KW;Kim YS;Chae DW;Kim S;Chin HJ
伊加肾病（IgAN）预后的研究主要集中在肾存活率上，关于患者存活率的信息很少。因此，本研究旨在探索IgAN患者的长期患者结局。回顾了1979年至2008年1,364例IgAN患者肾活检时的临床和病理特征。结局为患者死亡和终末期肾病（ESRD）进展。总体而言，在13，916人-年期间发生了71例死亡（5.3%）和277例ESRD病例（20.6%）。10年、20年和30年患者生存率分别为96.3%、91.8%和82.7%。超过50%的患者死亡没有发生ESRD进展。与年龄/性别匹配的一般人群（GP）相比，总死亡率升高了43%（标准化死亡率比[SMR]，1.43; 95%置信区间[CI]，1.04-1.92）。男性的死亡率与GP相当（SMR，1.22; 95% CI，0.82-1.75），但女性的死亡率是GP的两倍（SMR，2.17; 95% CI，1.21-3.57）。有肾脏风险因素（如初始肾功能不全）的患者（估计肾小球滤过率<60 ml/min/1.73 m2; SMR，1.70; 95% CI，1.13-2.46），收缩压≥140 mmHg（SMR，1.88; 95% CI，1.19-2.82）或蛋白尿≥1 g/天（SMR，1.66; 95% CI，1.16-2.29）的死亡率升高。然而，肾功能正常、血压正常、蛋白尿<1 g/d的患者的死亡率与GP相似。当通过计算诊断时存在的主要危险因素的数量进行危险分层时，低风险IgAN患者的死亡率与GP相同，而高风险患者的死亡率高于GP。这项调查表明，IgAN患者的总体死亡率高于GP。女性和有肾脏危险因素的患者的死亡率高于GP，因此，优化策略以减轻主要肾脏危险因素是降低患者死亡率的必要条件。
Research on the prognosis of IgA nephropathy (IgAN) has focused on renal survival, with little information being available on patient survival. Hence, this investigation aimed to explore long-term patient outcome in IgAN patients. Clinical and pathological characteristics at the time of renal biopsy were reviewed in 1,364 IgAN patients from 1979 to 2008. The outcomes were patient death and end stage renal disease (ESRD) progression. Overall, 71 deaths (5.3%) and 277 cases of ESRD (20.6%) occurred during 13,916 person-years. Ten-, 20-, and 30-year patient survival rates were 96.3%, 91.8%, and 82.7%, respectively. More than 50% patient deaths occurred without ESRD progression. Overall mortality was elevated by 43% from an age/sex-matched general population (GP) (standardized mortality ratio [SMR], 1.43; 95% confidence interval [CI], 1.04–1.92). Men had comparable mortality to GP (SMR, 1.22; 95% CI, 0.82–1.75), but, in women, the mortality rate was double (SMR, 2.17; 95% CI, 1.21–3.57). Patients with renal risk factors such as initial renal dysfunction (estimated glomerular filgration rate <60 ml/min per 1.73m2; SMR, 1.70; 95% CI, 1.13–2.46), systolic blood pressure ≥140 mmHg (SMR, 1.88; 95% CI, 1.19–2.82) or proteinuria ≥1 g/day (SMR, 1.66; 95% CI, 1.16–2.29) had an elevated mortality rate. Patients with preserved renal function, normotension, and proteinuria <1 g/day, however, had a similar mortality rate to GP. When risk stratification was performed by counting the number of major risk factors present at diagnosis, low-risk IgAN patients had a mortality rate equal to that of GP, whereas high-risk patients had a mortality rate higher than that of GP. This investigation demonstrated that overall mortality in IgAN patients was higher than that of GP. Women and patients with renal risk factors had a higher mortality than that of GP, Therefore, strategies optimized to alleviate major renal risk factors are warranted to reduce patient mortality.
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影响因子：
3.7
作者：
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